TY - JOUR
AU - M. Lamarre
AU - M. Daignault
AU - V. W. Cheung
AU - M. F. Forget
AU - Q. D. Nguyen
A1 - 
AB - BACKGROUND: As health-care demand is growing, our health-care system will require the optimization of the care trajectories. Patients with an alternate level of care (ALC) status could be a target for flow optimization. We aimed to characterize ALC patients and risk factors for ALC status, and to propose an integrated model to analyze the trajectory of ALC patients and discuss solutions to reduce their burden. METHODS: A case-control design was used to compare 60 ALC and 60 non-ALC patients admitted to the geriatric unit of the Centre hospitalier de l'Université de Montréal in 2021, collecting medical and sociodemographic data. Based on our model, univariate statistical analyses were computed to compare groups and identify risk factors for ALC status. RESULTS: ALC patients were less independent (22% performed five to six activities of daily living vs. 43%, p = .03). Both groups were comparable in terms of mobility and neurocognitive disorders. ALC patients were more likely to receive a new diagnosis of a neurocognitive disorder or new behavioural or psychological symptoms (37% vs. 15%, p = .008). Up to 25% of ALC patients were admitted despite presenting no active medical condition (vs. 3% of non-ALC patients, p = .002). CONCLUSIONS: The optimization of the care trajectory of ALC patients is mainly based on pre-hospital and post-hospital factors. A proportion of ALC admissions might be avoidable with additional investment in home care resources and relocation procedures. Fluidity of ALC trajectory may benefit from improved orientation at discharge procedures. Full optimization of ALC trajectories requires a systemic understanding of the health-care system.
AD - Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montréal, QC.; Division of Geriatrics, Centre intégré de santé et de services sociaux de Laval, Laval, Montréal, QC.; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC.; Department of Medicine, Université de Montréal, Montréal, QC.
AN - 38827424
BT - Can Geriatr J
C5 - Education & Workforce
CP - 2
DA - Jun
DO - 10.5770/cgj.27.697
DP - NLM
ET - 20240603
IS - 2
JF - Can Geriatr J
LA - eng
N2 - BACKGROUND: As health-care demand is growing, our health-care system will require the optimization of the care trajectories. Patients with an alternate level of care (ALC) status could be a target for flow optimization. We aimed to characterize ALC patients and risk factors for ALC status, and to propose an integrated model to analyze the trajectory of ALC patients and discuss solutions to reduce their burden. METHODS: A case-control design was used to compare 60 ALC and 60 non-ALC patients admitted to the geriatric unit of the Centre hospitalier de l'Université de Montréal in 2021, collecting medical and sociodemographic data. Based on our model, univariate statistical analyses were computed to compare groups and identify risk factors for ALC status. RESULTS: ALC patients were less independent (22% performed five to six activities of daily living vs. 43%, p = .03). Both groups were comparable in terms of mobility and neurocognitive disorders. ALC patients were more likely to receive a new diagnosis of a neurocognitive disorder or new behavioural or psychological symptoms (37% vs. 15%, p = .008). Up to 25% of ALC patients were admitted despite presenting no active medical condition (vs. 3% of non-ALC patients, p = .002). CONCLUSIONS: The optimization of the care trajectory of ALC patients is mainly based on pre-hospital and post-hospital factors. A proportion of ALC admissions might be avoidable with additional investment in home care resources and relocation procedures. Fluidity of ALC trajectory may benefit from improved orientation at discharge procedures. Full optimization of ALC trajectories requires a systemic understanding of the health-care system.
PY - 2024
SN - 1925-8348 (Print); 1925-8348
SP - 152
EP - 158+
ST - Factors Associated with Alternate Level of Care Status Designation: a Case-Control Study and Model to Optimize Care Trajectories
T1 - Factors Associated with Alternate Level of Care Status Designation: a Case-Control Study and Model to Optimize Care Trajectories
T2 - Can Geriatr J
TI - Factors Associated with Alternate Level of Care Status Designation: a Case-Control Study and Model to Optimize Care Trajectories
U1 - Education & Workforce
U3 - 10.5770/cgj.27.697
VL - 27
VO - 1925-8348 (Print); 1925-8348
Y1 - 2024
ER -